Clinical Reasoning in the Ward Setting: A Rapid Response Scenario for Residents and Attendings.
Clinical Competence
/ standards
Critical Care
/ methods
Delivery of Health Care
Education, Medical
/ methods
Evaluation Studies as Topic
Female
Health Knowledge, Attitudes, Practice
Hospital Rapid Response Team
/ organization & administration
Humans
Inpatients
/ statistics & numerical data
Male
Mental Processes
/ physiology
Patient Care Planning
Patients' Rooms
/ organization & administration
Physicians
/ statistics & numerical data
Pneumothorax
/ diagnosis
Qualitative Research
Simulation Training
/ methods
Thinking
/ physiology
Clinical Reasoning
Critical Care Medicine
Medical/Surgical Ward
Qualitative Research
Quantitative Research
Rapid Response
Scenario-Based Simulation
Simulation
Standardized Patient
Surgery
Tension Pneumothorax
Think-Aloud
Journal
MedEdPORTAL : the journal of teaching and learning resources
ISSN: 2374-8265
Titre abrégé: MedEdPORTAL
Pays: United States
ID NLM: 101714390
Informations de publication
Date de publication:
27 09 2019
27 09 2019
Historique:
entrez:
28
11
2019
pubmed:
28
11
2019
medline:
18
6
2020
Statut:
epublish
Résumé
There is a need for educational resources supporting the practice and assessment of the complex processes of clinical reasoning in the inpatient setting along a continuum of physician experience levels. Using participatory design, we created a scenario-based simulation integrating diagnostic ambiguity, contextual factors, and rising patient acuity to increase complexity. Resources include an open-ended written exercise and think-aloud reflection protocol to elicit diagnostic and management reasoning and reflection on that reasoning. Descriptive statistics were used to analyze the initial implementation evaluation results. Twenty physicians from multiple training stages and specialties (interns, residents, attendings, family physicians, internists, surgeons) underwent the simulated scenario. Participants engaged in clinical reasoning processes consistent with the design, considering a total of 19 differential diagnoses. Ten participants provided the correct leading diagnosis, tension pneumothorax, with an additional eight providing pneumothorax and all participants offering relevant supporting evidence. There was also good evidence of management reasoning, with all participants either performing an intervention or calling for assistance and reflecting on management plans in the think-aloud. The scenario was a reasonable approximation of clinical practice, with a mean authenticity rating of 4.15 out of 5. Finally, the scenario presented adequate challenge, with interns and residents rating it as only slightly more challenging (means of 7.83 and 7.17, respectively) than attendings (mean of 6.63 out of 10). Despite the challenges of scenario complexity, evaluation results indicate that this resource supports the observation and analysis of diagnostic and management reasoning of diverse specialties from interns through attendings.
Identifiants
pubmed: 31773062
doi: 10.15766/mep_2374-8265.10834
pmc: PMC6869982
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
10834Informations de copyright
Copyright © 2019 Ohmer et al.
Déclaration de conflit d'intérêts
None to report.
Références
Adv Simul (Lond). 2017 Jun 27;2:10
pubmed: 29450011
Acad Med. 2018 Jul;93(7):990-995
pubmed: 29369086
BMC Med Educ. 2017 Nov 15;17(1):211
pubmed: 29141616
Simul Healthc. 2007 Fall;2(3):183-93
pubmed: 19088622
MedEdPORTAL. 2018 Nov 16;14:10773
pubmed: 30800973
JAMA Intern Med. 2013 Mar 25;173(6):425-6
pubmed: 23440273
Adv Simul (Lond). 2017 Nov 21;2:23
pubmed: 29450024
J Trauma Acute Care Surg. 2013 May;74(5):1363-6
pubmed: 23609291
Arch Intern Med. 2005 Jul 11;165(13):1493-9
pubmed: 16009864
Acad Med. 2017 Jan;92(1):23-30
pubmed: 27782919
Med Educ. 2004 Oct;38(10):1095-102
pubmed: 15461655
MedEdPORTAL. 2018 Aug 17;14:10740
pubmed: 30800940
Nurse Educ Pract. 2016 Jul;19:12-8
pubmed: 27428686
Acad Med. 2016 Jul;91(7):1022-8
pubmed: 26650677
Med Teach. 2013 Sep;35(9):720-6
pubmed: 23805999
Med Educ. 2005 Jan;39(1):98-106
pubmed: 15612906
Soc Sci Med. 2013 Aug;91:32-8
pubmed: 23849236
Int J Nurs Educ Scholarsh. 2015 Feb 03;12:null
pubmed: 25719341
Adv Health Sci Educ Theory Pract. 2012 Mar;17(1):65-79
pubmed: 21505841
Med Educ. 2011 Sep;45(9):927-38
pubmed: 21848721
MedEdPORTAL. 2017 Nov 06;13:10650
pubmed: 30800851
J Patient Saf. 2010 Dec;6(4):199-205
pubmed: 21500605
Med Educ. 2005 Apr;39(4):418-27
pubmed: 15813765
Adv Health Sci Educ Theory Pract. 2015 Dec;20(5):1225-36
pubmed: 25753295
BMJ Qual Saf. 2012 Jul;21(7):535-57
pubmed: 22543420
MedEdPORTAL. 2016 Aug 26;12:10445
pubmed: 31008223
Med Teach. 2012;34(1):30-7
pubmed: 22250673
Med Educ. 2010 Jan;44(1):94-100
pubmed: 20078760
Acad Med. 2009 Aug;84(8):1022-8
pubmed: 19638766
Anesthesiology. 1988 Sep;69(3):387-94
pubmed: 3415018
JAMA. 2009 Mar 11;301(10):1060-2
pubmed: 19278949
JAMA. 2011 Jun 15;305(23):2427-31
pubmed: 21673294
MedEdPORTAL. 2017 Oct 23;13:10646
pubmed: 30800847
Br J Educ Psychol. 2005 Dec;75(Pt 4):645-60
pubmed: 16318683
MedEdPORTAL. 2016 Jul 21;12:10428
pubmed: 31008208
Adv Health Sci Educ Theory Pract. 2017 Aug;22(3):691-711
pubmed: 27469243